Provider Demographics
NPI:1316604887
Name:FAMILIES FIRST ORTHODONTICS
Entity type:Organization
Organization Name:FAMILIES FIRST ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-679-3024
Mailing Address - Street 1:13825 S. REDWOOD RD
Mailing Address - Street 2:100
Mailing Address - City:BLUFFDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84095
Mailing Address - Country:US
Mailing Address - Phone:801-679-3024
Mailing Address - Fax:801-679-3025
Practice Address - Street 1:13825 S. REDWOOD RD
Practice Address - Street 2:100
Practice Address - City:BLUFFDALE
Practice Address - State:UT
Practice Address - Zip Code:84095
Practice Address - Country:US
Practice Address - Phone:801-679-3024
Practice Address - Fax:801-679-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1891857579Medicaid